Individual
CHARLOTTE I MARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2920 S MCINTIRE DR, BLOOMINGTON, IN 47403-4221
(812) 353-3277
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002465A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540362
MEDICARE PTAN
IN
05
—
300014994
—
IN
Enumeration date
06/18/2018
Last updated
08/10/2023
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